Predictive Factors Associated with Pain Relief of Spinal Cord Stimulation for Central Post-stroke Pain

Abstract

The efficacy and predictive factors associated with successful spinal cord stimulation (SCS) for central post-stroke pain (CPSP) have yet to be definitively established. Thus, this study evaluated the rates of pain relief found after more than 12 months and the predictive factors associated with the success of SCS for CPSP. The degree of pain after SCS in 18 patients with CPSP was assessed using the Visual Analog Scale preoperatively, at 1, 6 and 12 months after surgery, and at the time of the last follow-up. After calculating the percentage of pain relief (PPR), patients were separated into two groups. The first group exhibited continuing PPR ≥30% at more than 12 months (effect group) while the second group exhibited successful/unsuccessful trials followed by decreasing PPR <30% within 12 months (no effect group). Pain relief for more than 12 months was achieved in eight out of 18 (44.4%) patients during the 67.3 ± 35.5 month follow-up period. Statistically significant differences were found for both the age and stroke location during comparisons of the preoperative characteristics between the two groups. There was a significantly younger mean age for the effect versus the no effect group. Patients with stoke in non-thalamus were significantly enriched in effect group compared with those with stoke in thalamus. Multivariable analysis using these two factors found no statistical differences, suggesting that these two factors might possibly exhibit the same behaviors for the SCS effect. These results suggest that SCS may be able to provide pain relief in young, non-thalamus stroke patients with CPSP.

Prevalence and Management Challenges in Central Post-Stroke Neuropathic Pain: A Systematic Review and Meta-analysis

“…Spinal cord stimulation (SCS) for the management of CPSP has been used in three open-label non-controlled studies, which suggested that SCS may provide improved long-term pain control (Level IV of evidence) [50,56,77].…”

Benefit of spinal cord stimulation for patients with central poststroke pain: a retrospective multicenter study

“…To our knowledge, among the studies that examined the outcomes of using SCS to treat patients with CPSP, our study included the greatest number of patients. [7][8][9][10][11][12]16,17 In this multicenter case series, 64% of patients presented with ≥ 30% decrease in pain score and 59% had much or very much improved condition on the PGIC scale at trial stimu- lation. Moreover, 59% of those who underwent long-term implantation continued to show ≥ 30% decrease in pain score, and 57% reported much or very much improvement on the PGIC scale at last follow-up.…”

“…10 patients with CPSP had ≥ 30% pain decrease at 24 and > 12 months after undergoing long-term SCS, respectively. 11,12 Additionally, 3 of 15 and 6 of 17 patients with CPSP treated with long-term SCS had satisfactory outcomes according to two case series written in Japanese. 16,17 The responder rates reported in previous studies vary from 7% to 83%.…”

“…To our knowledge, there are no randomized controlled trials (RCTs) of SCS for CPSP to date, and only several single-center case series have been reported (Table 5). [7][8][9][10][11][12]16,17 As mentioned in the introduction, based on the results of early case series 7,8 and the lack of RCTs, guidelines and consensus recommendations do not recommend application of SCS to treat patients with CPSP. [3][4][5] Since 2009, four case series have reported positive results.…”

“…However, recent single-center case series with small numbers of patients (range 6-30 patients) have reported possible efficacy, with responder rates of 23%-83%. [9][10][11][12] Because a study with a large number of patients is required to establish the efficacy of SCS as a treatment of CPSP, we conducted a retrospective multicenter study in Japan. Thus, we report the outcomes of trial and long-term stimulation with SCS in patients with CPSP and explore factors related to SCS outcomes.…”